For primary infertility, the first thing I would recommend is to have your ovarian assessment done and that will involve you having a scan. This scan will involve having a complete look at the shape and size of your uterus, presence of any fibroids, presence of any polyps (this scan can sometimes suggest if there are any large polyps) and looking at your follicular count on the ovaries. There is also a blood test which is the anti mullerian hormone (AMH) together with the follicle count and the blood test (AMH) we can conclude what your ovarian reserve is. So there may be a reason you have a very good reserve or you have poly-cystic ovaries and you are actually not ovulating and that could be a reason you are not conceiving. Or on the scan we could find out there are possible endometriotic nodules that you have so on the ovaries we can see some endometriotic cysts, so that could be a reason as to you not being successful. You may be someone who is having premature ovarian failure and your reserve is much lower than expected for your age and that could be a reason why you have not successfully fallen pregnant. So that is the first line of starting how to diagnose or how to start looking for why if you haven’t fallen pregnant.
In the fertility of a woman, we look at a few broad things. We look at her ovarian reserve, so that is roughly speaking the number of eggs that are present in the ovaries, we look at whether she’s ovulating, so that goes by the regularity of her cycles and sometimes, we do a progesterone level in the middle of the second half of the menstrual cycle (about a week before the period is expected). We usually also do a pelvic ultrasound scan – this helps us examine the ovaries and also the uterus itself – we’re looking for things like ovarian cysts, we are looking for polycystic ovaries, for fibroids in the uterus and other swellings (such as swellings in the fallopian tubes which may indicate tubal damage). So those are the kind of basic set of test tests for women. Sometimes, depending on the history, we might recommend specific tests to look at the fallopian tubes – to check whether they are open or not, so that could be another test that you have. Of course, for men, the main test is a semen analysis.
